Method and apparatus for bathing body cavities

ABSTRACT

An endoscope and the like comprising a shaft having independent conduit means for delivering and withdrawing fluid extending from its proximal to distal end. Pump means for pump fluid to and from the body cavity. The pump being operated to deliver and withdraw an equal volume simultaneously.

U Umted States Patent 1191 1111 3,841,330

Storz 1 Oct. 15, 1974 [54] METHOD AND APPARATUS FOR BATHING 754,2763/1904 Bartsch 128/240 X BODY CAVITIES 3,329,147 7/1967 128/2303,481,334 12/1969 Diskin e1. 111.... 128/230 Inventor: Karl Smrl,Hermannstrasse 3,527,203 9/1970 Gravlee 128/241 x Tuttlingen, Germany3,626,928 12/1971 Hohokus et a1 128/278 3,636,940 1/1972 Gravlee v128/241 X [22] H 1973 3,675,653 7/1972 Crowley et a1 128/278 [21 1 Appl.No.: 323,654

Primary Examiner-Richard A. Gaudet Assistant Examiner-.1. Yasko IApplication Pnomy Dam Attorney, Agent, or F irmMurray Schaffer May 16,1972 Germany 2223760 [52] US. Cl. 128/230, 128/4 [57] ABSTRACT [51] Int.Cl A6lm 1/00 endoscope and the like Comprising a Shaft having [58] Fieldof Search 128/230, 241, 240, 2 B, independent conduit means fordelivering and with- 128/227, 228, 278, 350, 4 drawing fluid extendingfrom its proximal to distal end. Pump means for pump fluid to and fromthe body [56] References Cited cavity. The pump being operated todeliver and with- UNITED STATES PATENTS draw an equal volumesimultaneously.

443,083 12/1890 Bartsch 128/240 X 1 Claim, 2 Drawing Figures PATENTED[JCT 1 51974 SHEET 10F 2 METHOD AND APPARATUS FOR BATHING BODY CAVITIES'BACKGROUND OF THE INVENTION The present invention relates to medicaloperating devices and in particular to a device such as an endoscopeemploying means for simultaneously bathing a body cavity. 1

Devices such as endoscopes are well known for performing many types ofoperations, particularly in transurethal, urinary and bladder sections.In such operations the removal of a bladder tumor or growth in thebladder or bladder-neck is accomplished by employing high frequencycurrent during which it is preferable to first expose the bladder or atleast the situs of the operation to view and then to perform theelectrical cutting while simultaneously bathing the area with a fluidmedia, as for example water. In order to maintain the field of visionfree of blood and other material a water stream having a measurablepressure must be provided. Accordingly, the endoscope used for theoperation has been provided with conduit means for delivering the vfluid to the situs of the operation. In the known devices thecross-section of the fluid feeding channel has been so large that about1 liter of water per minute to the bladder is provided. This results inthe rapid filling of the bladder and requires that as much tissue be cutby the doctor as soon as possible, since the filling of the bladder isannoying to the patient, and if it is filled too much, does the patientserious jeopardy. Because of this, it has been necessary when using theknown devices, to interruptthe operation as often as 50 times, in orderto remove the accumulated water. This drainage of the bathing watertakes virtually as much time as the actual operation itself. Thisdisadvantage is so severe that it hampers and reduces the efficiency ofthe bathing and as well as the display of the bladder to the doctor andalso the clearing of the field of vision.

Attempts have been made to overcome the above disadvantages through theprovision of a return duct by which the fluid may be removed. In onedevice the annular chamber within the endoscope shaft is used as thebathing media channel and a connecting socket for the infeed anddischarge of the media is fastened to the head portion of the endoscopeshaft itself. German Utility Pat. 1,980,836 shows such a device. Thelimited area wherein both the channel for the infeed and the duct forthe discharge are arranged, hinders and prevents the full flow of themedia stream. In addition the actual connection for the return flowduct, because of structural imitations, is rather narrow, that is, itscrosssection is significantly smaller than the cross section of theinfeed channel. As as consequence, much more bathing fluid media flowsinto the bladder than flows outwardly therefrom so that filling of thebladder occurs, anyway. Therefore, even with the use of this device, theoperation must be interrupted periodically in masses act to block andclose up the filter means very quickly, this system has its limitations.In addition, this system has the disadvantage that fresh bathing liquidis not delivered to the bladder, since the bathing liquid circulates ina closed system.

The present invention has as its object the provision of apparatus andparticularly an improved endoscope means which overcomes thedisadvantages of the prior art and provides means for performing theoperation of the type described without interruption and with thesecurity desired.

SUMMARY OF THE INVENTION The object of the present invention is obtainedby providing an endoscope device in which bathing media is continuouslywith or intermediate the operative steps in short succeeding intervalssimultaneously pumped into and out of the body cavity, the inveed andthe discharge being maintained in equal volume. In this manner it isassured that during the operation the delivered bathing media is alwaysequal to the discharged bathing media volume. This prevents the excessfilling of the bladder in every instance. It is, therefore, possible forthe first time to continue the operation from beginning to end withoutinterruption. The bladder may thus be filled with a standing watercolumn, before the operation is commenced and then the tissue cut can bemade with the bladder full of bathing liquid as is most desirable from amedical point of view. Nevertheless, in accord with the presentinvention, once the operation is commenced, an exchange of equal volumeof liquid may be effected, so that while the bladder constantly remainsfull, the liquid together with tissue, blood, etc., is withdrawn,cleansed and recirculated and fresh liquid added. At no time does excessliquid accumulate in the bladder. I

In accordance with the present invention the pumping of the bathingmedia into and out of the body is accomplished through the use of atubular pump having a feed and discharge tube arranged in parallel and arotary actuator eccentrically arranged between them. This structure hasthe particular advantage that the eccentric actuator can be arranged andconnected simultaneously to pressurize the feed tube and to exhaust thedischarge leading to the corresponding members in the endoscope device,so that it can control simultaneously both the feeding and discharge ofliquid through the device. This arrangement has further advantages inthat it is of great simplicity, it is exteremely efiicient and insuresthat both the pumping in and exhausting out of the bathing fluid iscreated from a single source having the same stroke frequency and volumeof pumping.

In accordance with a further feature of the present invention theendoscope shaft may be formed having first a nozzle portion at thedistal end of the shaft by which the bathing media is delivered directlyto the site of the operation, and a second separate discharge channelfrom the site. The connection for the actual intake and for thedischarge of the media may then be arranged on the headportion orproximal end of the endoscope shaft. This arrangement has the advantagethat separate channels or ducts can be provided through the endoscopefor the intake and for the outlet of fluid. Further, the dischargechannel can be made at least equal to or greater in cross-section thanthe inlet channel. Preferably, the cross-section of the inlet channel ismaintained substantially smaller than the discharge channel so that ahigh enough pressure is developed to wash the tissue from the lens etc.,but accumulation of the'liquid in the cavity is avoided. In addition,through the separation of the discharge channel from the inlet channelit is insures that at least the same volume of fluid is pumped out ofthe body cavity as is pumped into it.

A further feature of the present invention resides in the provision thatthe inlet channel is formed in the nature of a throat or bulge arrangedabout the viewing tube of the endoscope whereby the throat provides anannular channal closed with respect to the viewing tube and separatetherefrom. Further this construction permits the viewing tube to beindependently and removably inserted in the shaft so that it can bewithdrawn easily and simply for cleaning and sterilization. In addition,the interior of the shaft is also available by being removable of theviewing tube for cleaning and sterilization. The prior techniques ofsoldering the inlet channel on the viewing tube, and thus requiring asmall cross-section is avoided.

Further details and particulars of the invention are given in thefollowing disclosure and will be seen in the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a plan view of apparatusembodying the present invention which is connected to an endoscopedevice, seen extending perpendicularly to the plan of the drawing; and

FIG. 2 is a partially sectional elevational view of the endoscopeadapted to receive the apparatus of the present invention.

DESCRIPTION OF THE INVENTION The Figures show an endoscope adapted foruse in transurethral operations, and bladder sections of the knowndevices and is generally of the construction well known in the art.Similar devices, adapted for body insertion, may be employed. Because ofthe wide knowledge in the art of such devices, the drawings areschematic only, and of conventional structure, and therefore either notshown or described herein. Reference, however, is made to the inventorscopending applications, Ser. No. 177,349, 177,350 now US. Pat. No.3,791,379, 177,353 now abandoned, all filed Sept. 2, 1971, shoulddetails thereof be required for further understanding of this invention.

As seen in the Figures, the device comprises an endoscope shaft 14carrying at its proximal end a sleeve-like or throat connection 14a fora first inlet 12 having adjustable pet-cock valve and a second inlet 13through which fluid media may be delivered. As seen in FIG. 1, attachedto the inlets l2 and 13 respectively are resilient flexible infeed tubes7 and 9, which are jointly connected to a Y-connection l 1 which is inturn connected to means for storing the liquid media such as a bottle10. Located above the connection 14a is an outlet 25 to which isconnected to the end of a resiliently flexible discharge tube 8. Theoutlet 25 is not seen in FIG. 2, since it lies at right angles to theinlets l2 and 13, but is adapted to be formed at the upper end of theendoscope and to be in communication with an annular chamber 2 formedinternally within the shaft 14, between the viewing tube 4 and the wallof the shaft 14. The inlet 13 is in communication with a channel 1passing formed by a tube passing through a groove in endoscope shaft 14,extending in the longitudinal direction with the guide tube 3.

As seen in FIG. 2 the endoscope comprises an optical eyepiece 24 mountedat the upper end of a viewing tube 4', which extends through asurrounding guide tube 3. At the lower end of the viewing tube 4 thereis located an objective lens 15 through which the situs of the operationcan be viewed by the doctor. The viewing tube is set within theendoscope shaft 14 and thus forms the annular discharge channel 2. Thechannel 1 is formed by a tube or tubular section formed along the lengthof the guide tube 3 and the viewing tube 4. As seen in FIG. 2, a portionof the viewing tube 4 and the exterior endoscope shaft 14 extends beyondthe point at which the lens 15 is secured, thus extending the dischargechannel 2 below the lens. On the other hand a portion of the shaft 14terminates above the lens 15 so that the channel 2 opens at a levelhigher than the lens 15. It will also be observed that the dischargechannel 2 has a greater cross-sectional area than the inlet or feedchannel 1.

An elongated wire having a loop 16 at its lower end extends between theendoscope shaft 14 and the viewing tube 4 below the lens 15. The wire 16is secured to a movable sleeve 17 located about the guide tube 3 whichis connected via a finger grip 21 and an articulated pair of levers l8and 22 to a boss at the upper end of the endoscope on which the eyepiece is secured. The boss contains a palm or hand grip 23 permittingthe carrier sleeve 17 to be movable axially along the tube viewing tube4 by manipulation of the finger grip 21. In this manner the wire loop 16may be extended or retracted with respect to the situs of the operation.The wire loop 16 of the course comprises the electrode of the highfrequency apparatus and is connected to a suitable power source in knownmanner. The connection 14 a for the inlets l2 and 13 sits above theshaft 14 and has a small conduit which connects the inlet 12 to theannular channel 2. The inlet 12 is provided with the pet-cock so that itcan be opened and bathing fluid delivered directly through thisdischarge channel 2 into the body cavity so that the bladder may beinitially filled with a predetermined amount of liquid via the largerdischarge channel so that the conductive electrode will have sufficientconducting media and the cavity will be sufficiently bathed, before themoment at which the operation may begin.

Returning to FIG. 1 the inlet tube 7 from inlet 13 and the outlet tube 8from discharge 25 pass through a pump 5 having a rotatable eccentricactuator 6. The pump 5 comprises a body in which a rotary motor having ashaft on which the actuator 6 is mounted. The tubes 7 and pass throughgrooves in the body parallel to each other and substantially tangentialto the actuator, which is adapted to engage both the tubes 7 and 8simultaneously. The actuator 6 compresses the tubes in rhythmic sequenceso as to pump fluid through tube 7 and exhaust fluid through tube 8. Thetubes 7 and 8 and the excenter 6 are positioned relative to each otherthat the stroke, and the fequency of the pumping action is the same onboth tubes, although in opposite phase or direction and the volume ofcompressed fluid in each of the tubes is the same. Therefore,simultaneously a similar volume of fluid may be pumped into the bodycavity as is withdrawn. Actually, during use of the device, the pet-cockconnection 12 is opened so that the cavity is initially filled to themost optimal level for the operation. Thereafter, it is closed so thatliquid is delivered only through the smaller inlet 13 and channel 1 bythe operation of the pump 5. Simultaneously the same volume of fluid iswithdrawn from the site of the operation through the discharge channel2. The inlet connection 13 passes through a cut in the wall of theendoscope shaft 14 and is soldered or welded to the tubular channel 1 toprovide a fluid tight arrangement so that the infeed of liquid is sealedfrom the connection 12. The feed channel 1 extends the length of viewingtube 4 and opens in the neighborhood of the objective lens 15 so thatthe liquid pumped through the nozzle-like opening tends to pass overthis objective lens 15 maintaining it free of any blood or particlesduring the operation. The discharge flow of the liquid passes throughthe opening in the annular discharge channel 2 one portion of which isimmediately adjacent the electrode wire loop 16 and the other portion ofwhich is located above the objective lens 15. In this way a current offluid from the inlet to the outlet is created insuring absolute cleaningof both the situs of the operation and the distal end of the endoscope.

The eye piece 24 and the viewing tube 4 are jointed together to beremovable axially from the endoscope shaft 14 by being pulled upwardlythrough the sleeve 17 and the boss holding the lever 22. By removing theeye piece 24 and the tube 4 on completion of or even during theoperation the bladder can be easily and quickly emptied, since theliquid in the bladder will all run quickly through the hollow interiorof the endoscope shaft 14 without interruption. This is advantageousparticularly should an emergency occur during the operation whichrequires instantaneous emptying of the bladder. With the presentinvention, removal of the device permits the eye piece to be cleaned andsterilized and opens the entire enterior of the endoscope to cleaningand sterilization also.

The present device is employed by first inserting the endoscope shaft 14together with the viewing tube 4 in the body cavity with the pet-cockopened so that the body cavity is filled with the bathing liquiddelivered from the reservoir 10 through the annular discharge chamber 2.The pump 5 is arranged so that the discharge tube 8 is closed so thatthe liquid does not prematurely flow out of the body. A pet-cock orother clamping valve mechanism may be used on the tube 8 rather thanusing the pump to close the tube 8. Such mechanism may be located eitherdirectly on the tube or on the discharge connection 25. The pump 5 isthen activated upon the beginning of the operation itself and anadditional amount of fluid is directed via the Y-joint 11 into the tube7, to the site of the operation through the inlet channel 1. Since theinlet channel 1 is of a smaller cross-sectional area than the dischargechannel 2 the amount of fluid passed into the bladder in this directionis so great as to cause excess filling of the bladder.

As soon as the body cavity is filled in the described manner, thepet-cock 12 is closed and if a clamp is used the clamp or other devicein discharge connection 25 and discharge tube 8 is opened. Thereafterthe doctor may begin his work and perform the operation by activatingthe electrode 16. The pump 5 is continuously operated so as tocontinuously feed and withdraw a constant amount of fluid-from the bodycavity during the course of the operation. On the other hand, ifdesired, the doctor may operate the pump at intervals and only when thedoctor considers it necessary to remove blood and tissue from the siteof the operation. In either event, the same volume of water is deliveredto the body cavity as is simultaneously removed therefrom setting up acirculation of fluid about the objective lens 5, the electrode 16, aswell as in the site of the operation so that the site is maintained inclean and suitable condition for the continuation of the operation.

Since the discharge channel 2 is larger in crosssection than the inletchannel 1 it is clear that the body cavity will at no time be filledwith an excess of fluid and further the blood particles, tissueparticles, and other solid material withdrawn will easily pass throughthe discharge channel. The bladder is constantly maintained with anoptimal amount of fluid providing the necessary conductive media for theelectrode as well as suitable bathing and therapeutic media. The smallerinlet cavity has a further advantage in that, while the same volume offluid is directed into the body as is removed therefrom, the smallercross-section increases the pressure of the fluid so that the completeand proper washing of the area is obtained. It also should be noted thatthe mouth of the inlet channel 1 is positioned between the mouth of theoutlet channel 2 so that the two are not in close proximity to eachother and thus the incoming water can not be diverted to the outletwithout further performing its cleaning function.

Various modifications and embodiments will of course be evident to thoseskilled in this art. Accordingly, the foregoing disclosure is to betaken as illustrative only, and not limiting of the scope of the presentinvention.

What is claimed:

1. In combination, an endoscope or similar apparatus for operating in abody cavity comprising a substantially hollow shaft having first andsecond conduit means extending between the proximal and distal endsrespectively for the delivery and withdrawal of fluid from said body,and tubular pump means comprising a flexible hose extending respectivelyfrom said delivery and withdrawal conduit means and a rotary eccentricactuator acting thereon for simultaneously pumping an equal volume offluid through said first and second conduit means to and from said body.

1. In combination, an endoscope or similar apparatus for operating in abody cavity comprising a substantially hollow shaft having first andsecond conduit means extending between the proximal and distal endsrespectively for the delivery and withdrawal of fluid from said body,and tubular pump means comprising a flexible hose extending respectivelyfrom said delivery and withdrawal conduit means and a rotary eccentricactuator acting thereon for simultaneously pumping an equal volume offluid through said first and second conduit means to and from said body.